0．23T开放性磁共振实时导引下经皮肝脏肿瘤激光热消融术  

The real-time MRI （0.23T open scanner） guidance and monitoring in percutaneous laser ablation of liver primary and secondary tumors

作　　者：李成利[1] 武乐斌[1] 陈立光[1] 史浩[1] 林徵宇[1] Robert Blanco Sequneir 

机构地区：[1]山东省医学影像学研究所,250021 [2]芬兰Oulu大学医院

出　　处：《Journal of US-China Medical Science》2005年第3期27-33,共7页美中医学（英文版）

摘　　要：目的首先是阐述安装在0．23T磁共振扫描仪上的光学器械跟踪系统的精确导引、定位和实时监测磁共振介入肝脏肿瘤激光治疗中的热消融变化；其次是描述激光消融治疗肝脏原发和继发性肿瘤的可行性与安全性。方法14例患者（11男，3女，平均年龄63．5岁）经病理学活检证实的22个肿瘤（4例为肝细胞癌，10例为肝转移瘤）进行了经皮激光热消融治疗术。进行激光热消融的介入导引与热监测光学器械导引硬件和软件（Ipath200，Philip医疗系统，芬兰）采用0．23T开放性磁共振扫描系统。结果全部病灶在磁共振导引下均被成功地定位、靶定并消融治疗，术后3天患者出院。T1加权像与T2加权像上，被消融之肝组织结构的形态及体积均能清楚显示。增强磁共振成像扫描图像上，消融毁损区域显示为无血管和坏死热病灶。肿瘤的大小、术后瞬间及3天后热消融形成的凝固坏死灶的大小均得以在磁共振图像上显示。本组病例中，除一例（术后残余）外，所有热消融灶均显示大于各自原始肿瘤大小；且术后3天所形成的热消融凝固灶显示有统计学意义。结论磁共振导引经皮肝脏肿瘤的激光热消融术是可行和安全的；光学追踪系统导引与磁共振的温度监测对准确估计热治疗的效果是一有用且可信赖的工具。Objective To demonstrate the real-time optical instrument tracking system integrated to the MRI scanner as a guidance and monitoring facility in positioning instrument and monitoring ablation of liver tumors of interventional MRI at open 0.23T; To describe the feasibility and safety of laser ablating liver prima y and secondary tumors, Methods 22 hepatic tumors in 14 patients （11 males, 3 females, mean ages： 63.5y） were treated （total thermal ablation）. 10 are metastases and 4 primary malignancies. All were proved by biopsy. A low field open configuration MRI scanner （0.23T, Philips Medical Systems） with optical instrument guidance hardware and software was used. Results All the lesions scheduled were successfully localized, targeted, and treated under MRI guidance. All the patients treated were discharged 3 days after interventions. With both T1WI and T2WI, the ablated liver tissues were exactly depictable and provided precise delineation of the ablated tissue volume. On post-procedure simultaneously and follow-up contrast-enhanced MR images, the thermal ablated lesions appeared avascular and necrotic. MR showed the size of the initial tumor, and the size of the coagulative necrosis after procedure immediately and 3 days later, in which all but one were slightly larger than initial tumors respectively. There was statistically significant difference in mean maximum of necrosis diameter between intraprocedure and that of 3 days later on T1- and T2-weighted images. Conclusion MRl-guided percutaneous laser thermal ablation of liver tumors is both feasible and safe; the optical tracker system and intraprocedural thermal monitoring with MRI proved to be useful and reliable tool for estimating the effects of thennotherapy accurately.

关 键 词：开放式磁共振 实时磁共振导引与监测 经皮激光消融 肝脏原发性肿瘤 肝脏继发性肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]